Making Communication, Decision

By Paula Musich  |  Posted 2006-07-30 Print this article Print

-Making Easier for Everyone"> "It was considerably less expensive than the others, it largely covered what we wanted and it was easy to implement," Harrop said. Both the agent-based eQ and agentless Longitude tools were chosen so that operators could monitor all systems associated with the Epic software—even those systems deemed too sensitive to handle the installation of an active agent.

"For systems that we require more granular data from, we tend to put an agent on those boxes, and well monitor that way. Longitude we use for more ad hoc reporting or if we need to take a quick look at something," Harrop said.

The Heroix software, already in use for managing other servers such as Fallons Microsoft Exchange mail servers, has proved its mettle.

"We learn of problems before the end user sees it." Paul said. "The system pages our engineers for critical problems, sends us informational messages about mounting problems such as a CPU that has too many processes running, and will restart stopped services on a server and let us know it did that."

Records system in place as the infrastructure up­grade progressed, another team at Fallon in early 2005 began the implementation planning process for Epic. A Fallon project team was selected, trained and certified on Epic, while Epic put together its own team of support people and system integrators to help with the implementation. Both teams developed a project plan and then came together with key stakeholders—including physicians and nurses—to dive into the details of the workflow that would be automated through Epic.

"You document the workflow and apply it to every variation of the patient encounter," said Richard Morel, director of Epic implementation at Fallon. "You have to build into Epic the workflows to enable the electronic transfer, create the blueprints for building a production system, [and] then move into training, actual implementation and support."

The first phase of the implementation—the practice management system rollout—took place in April, when IT staff with the help of Epic consultants deployed the Epic Resolute billing system, Prelude patient registration program and Cadence scheduling program. The second phase, the actual EHR system called Epicare, is broken up into three stages. The first stage—lab order entry and results—was implemented in May, when existing data was converted to Epic.

"One of the things I find most marvelous about what were doing [is that] when most organizations turn on their e-health record, its empty," Garber said. "As we turn this on, we have 22 years of medications, allergies, lab results, radiology reports [and] progress notes completely populating the e-health record from Day One."

The second stage, telephone messaging and electronic prescriptions, began in June and is expected to be completed in November. That involves moving historical pharmacy data to Epicare; new pharmacy data will be available in Epicare as well.

"The phone messaging piece of Epic allows a [staff member] to take a phone message for a physician, enter it in the system [and] it goes to the physicians in-basket, where they can respond," Paul said. "They can create a prescription electronically, and the system can fax it to the pharmacy. He can make a call or give a medical assistant instructions on how to deal with the patient. Thats all electronic. Before, it had been all manual."

The third and biggest stage, with full provider documentation in the exam room, will begin in early 2007, said Morel.

The benefits expected of the system are numerous. Even in the short time the practice management system has been in place, Fallon has already seen that "charges are starting to flow through a lot faster, and were [experiencing] a reduction in payment delays," said Paul. Beyond that, the system promises to streamline workflows; deliver better information in a timely fashion to improve decision making; reduce errors; and, ultimately, lower costs.

Lower Costs

In general, EHR systems benefit patients because fewer mistakes are made, so patients have better outcomes, and they receive more efficient care, "which means they may be able to leave the hospital a day early," said Barry Hieb, research director at Gartner Healthcare Group, in Tucson, Ariz. "You get better communication between all providers. A lot of times, it takes days to get information back to a private physician. Now that information can be transferred electronically, so there are no delays, omissions, errors."

A recent survey reports that hospital CIOS are getting on board with EHRs. Click here to read more. "With an e-health record, a specialist has access to the primary care record where he needs it, when he needs it. It cuts across a confusing communications conundrum," Morel said.

The advances made in EHR systems, such as those from Epic and Cerner, begin to make it possible to put new research into practice much faster. That concept, known as evidence-based medicine, can be used to help guide physicians in decision making.

"So as they are entering an order, the system will check that order and come back and say, Did you know theres another drug that does this better at half the cost?" Hieb said.

In cases of medical malpractice, 80 percent of the cases are attributed to errors of omission, "where the doctor forgot to do something or something slipped through the cracks," said Hieb. "This is where things like the information systems now are getting to the point where they can really kick in and make safety rails for medical practice."

The whole system will pay for itself, although it will take time for that to occur. Seven years from now, Fallon expects to save about $6 million a year in reduced costs for transcription and paper medical records, malpractice insurance, entering visit and procedure charges, paper supplies, shredding disposal and courier costs, as well as in fewer rejected claims.

As an early adopter, Fallon has a leg up on other providers still working with paper, although it took a lot to get there. While IDC says the average provider organization spends about 3 percent of its revenue on IT, Fallon is spending 13 percent on IT during the Epic implementation. But Fallon and its patients will reap the benefits.

"Were not bleeding-edge. This isnt going to kill us. But were leading a wave of physicians moving into a new form of health care," Garber said. Check out eWEEK.coms for the latest news, views and analysis of technologys impact on health care.


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